Ureteral Reconstruction With Ileum: Long-term Follow-up of Renal Function

Joshua D. Roth, Maria Francesca Monn, Konrad Szymanski, Richard Bihrle, Matthew J. Mellon

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: To assess long-term renal preservation and surgical outcomes in patients undergoing ureteric substitution with ileum. This has been a mainstay of reconstruction options for lengthy ureteral defects. Methods: Consecutive patients aged 18 or older undergoing ileal ureters at our institution were retrospectively reviewed (from 1989 to June 2013). Patients with <6 months of follow-up were excluded. Demographic, surgical, and renal functional outcomes were reviewed. Renal function was assessed by the Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease Study equations. Results: Of the 108 patients meeting the inclusion criteria, 86 (79.6%) had single-renal unit reconstruction and 22 had bilateral reconstruction. Eighty-four (77.8%) had radiation-induced stricture and 24 had iatrogenic or trauma-induced strictures. The median follow-up was 51 months (interquartile range: 22-112). Short-term complications included Clavien grade I (16 [14.8%]), Clavien grade II (3 [2.8%]), Clavien grade III (9 [8.3%]), and Clavien grade IV (3 [2.8%]). Long-term complications included fistula in 6 patients (5.6%), renal failure requiring dialysis in 2 patients (1.9%), hyperchloremic metabolic acidosis in 4 patients (3.7%), and incisional hernia in 11 patients (10.2%). Nine patients (8.3%) had small-bowel obstructions; 3 (2.8%) required adhesiolysis. Four patients (3.7%) had an anastamotic stricture. Nineteen patients (17.6%) had worsening renal function. Cox proportional hazards regression found that those with bilateral repair were at 3.7 times increased risk of worsening renal function (P = .02). Conclusion: Ureteral substitution with ileum provides an effective and versatile long-term reconstructive option with minimal renal function compromise in properly selected patients. Bilateral reconstruction may contribute to worse long-term renal function.

Original languageEnglish (US)
JournalUrology
DOIs
StateAccepted/In press - Nov 4 2016

Fingerprint

Ileum
Kidney
Pathologic Constriction
Diet Therapy
Ureter
Acidosis
Chronic Renal Insufficiency
Fistula
Renal Insufficiency
Dialysis
Epidemiology
Demography
Radiation

ASJC Scopus subject areas

  • Urology

Cite this

Ureteral Reconstruction With Ileum : Long-term Follow-up of Renal Function. / Roth, Joshua D.; Monn, Maria Francesca; Szymanski, Konrad; Bihrle, Richard; Mellon, Matthew J.

In: Urology, 04.11.2016.

Research output: Contribution to journalArticle

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title = "Ureteral Reconstruction With Ileum: Long-term Follow-up of Renal Function",
abstract = "Objective: To assess long-term renal preservation and surgical outcomes in patients undergoing ureteric substitution with ileum. This has been a mainstay of reconstruction options for lengthy ureteral defects. Methods: Consecutive patients aged 18 or older undergoing ileal ureters at our institution were retrospectively reviewed (from 1989 to June 2013). Patients with <6 months of follow-up were excluded. Demographic, surgical, and renal functional outcomes were reviewed. Renal function was assessed by the Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease Study equations. Results: Of the 108 patients meeting the inclusion criteria, 86 (79.6{\%}) had single-renal unit reconstruction and 22 had bilateral reconstruction. Eighty-four (77.8{\%}) had radiation-induced stricture and 24 had iatrogenic or trauma-induced strictures. The median follow-up was 51 months (interquartile range: 22-112). Short-term complications included Clavien grade I (16 [14.8{\%}]), Clavien grade II (3 [2.8{\%}]), Clavien grade III (9 [8.3{\%}]), and Clavien grade IV (3 [2.8{\%}]). Long-term complications included fistula in 6 patients (5.6{\%}), renal failure requiring dialysis in 2 patients (1.9{\%}), hyperchloremic metabolic acidosis in 4 patients (3.7{\%}), and incisional hernia in 11 patients (10.2{\%}). Nine patients (8.3{\%}) had small-bowel obstructions; 3 (2.8{\%}) required adhesiolysis. Four patients (3.7{\%}) had an anastamotic stricture. Nineteen patients (17.6{\%}) had worsening renal function. Cox proportional hazards regression found that those with bilateral repair were at 3.7 times increased risk of worsening renal function (P = .02). Conclusion: Ureteral substitution with ileum provides an effective and versatile long-term reconstructive option with minimal renal function compromise in properly selected patients. Bilateral reconstruction may contribute to worse long-term renal function.",
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AU - Mellon, Matthew J.

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N2 - Objective: To assess long-term renal preservation and surgical outcomes in patients undergoing ureteric substitution with ileum. This has been a mainstay of reconstruction options for lengthy ureteral defects. Methods: Consecutive patients aged 18 or older undergoing ileal ureters at our institution were retrospectively reviewed (from 1989 to June 2013). Patients with <6 months of follow-up were excluded. Demographic, surgical, and renal functional outcomes were reviewed. Renal function was assessed by the Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease Study equations. Results: Of the 108 patients meeting the inclusion criteria, 86 (79.6%) had single-renal unit reconstruction and 22 had bilateral reconstruction. Eighty-four (77.8%) had radiation-induced stricture and 24 had iatrogenic or trauma-induced strictures. The median follow-up was 51 months (interquartile range: 22-112). Short-term complications included Clavien grade I (16 [14.8%]), Clavien grade II (3 [2.8%]), Clavien grade III (9 [8.3%]), and Clavien grade IV (3 [2.8%]). Long-term complications included fistula in 6 patients (5.6%), renal failure requiring dialysis in 2 patients (1.9%), hyperchloremic metabolic acidosis in 4 patients (3.7%), and incisional hernia in 11 patients (10.2%). Nine patients (8.3%) had small-bowel obstructions; 3 (2.8%) required adhesiolysis. Four patients (3.7%) had an anastamotic stricture. Nineteen patients (17.6%) had worsening renal function. Cox proportional hazards regression found that those with bilateral repair were at 3.7 times increased risk of worsening renal function (P = .02). Conclusion: Ureteral substitution with ileum provides an effective and versatile long-term reconstructive option with minimal renal function compromise in properly selected patients. Bilateral reconstruction may contribute to worse long-term renal function.

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